The intersection of age, sex, race and socio-economic status in COVID-19 hospital admissions and deaths in South Africa (with corrigendum)

Lung Cancer in South Africa.

Can Cyprus overcome its health-care challenges?

South Africa is an upper middle–income country with a population of 59.6 million people (1). Gauteng is the most densely populated province, and houses 26% of the population, followed by KwaZulu-Natal (19%), and the Western Cape (12%). About 29% of the population are <15 years old and 9% are ≥60 years. Approximately 13% of the population are seropositive for HIV. Life expectancy is estimated at 68.5 years for females and 62.5 years for males, whereas the infant mortality rate is 23.6 per 1000 live births. In 2019, the gross national income per capita was approximately $6040 (Atlas method, current US$), with 8% of the country’s gross domestic product spent on health care (2). Despite the transition to democracy in 1994, a high level of inequality remains, reflected in a Gini coefficient of 0.63 and an unemployment rate of 30% (2,3). This inequality is also reflected in a two-tiered health system. Access to a well-resourced private health care sector depends on the ability to pay for services, usually via medical insurance. Treatment for CKD is included in the set of “prescribed minimum benefits” that all registered medical insurance schemes in South Africa are obliged to provide for their members. The majority of South Africans (84%), however, are dependent on an under-resourced, government-funded, public health care sector. Public health care facilities use a sliding scale, where the fees charged are dependent on income. Indigent patients are able to access services free of charge (4). South Africa is faced with a high burden of infectious diseases (such as tuberculosis and HIV infection), noncommunicable diseases, maternal and childhood diseases, and injury-related diseases (5). These factors drive an epidemic of AKI and CKD. Two studies have estimated the population prevalence of CKD in South Africa. Adeniyi et al. (6) reported the …

Purpose : Strategic performance measurement and management (SPMM) as a subject has come over increased research radar over the last four or so decades. The so-called “performance measurement revolution” of the 1980s to 1990s concentrated on the private sector. “Business managerialism” and “accountingisation” kicked-in into the public sector with transplanting of hitherto private sector management techniques under New Public Management (NPM) and other administrative reform programmes by various governments internationally. Specifically, the 1990s saw the implementation of modern multi-dimensional SPMM systems originally in the private sector. Considering the nuanced nature of the public sector, the transfer of SPMM systems from the private to the public sector has not been straightforward due to technical, conceptual and behavioral factors. This paper contrasts the features of the private and public sectors and investigates the implication of the distinctive nature of the public sector on the application of SPMM in the public sector. This will augment our perceptions and comprehension of existing public sector SPMM theory and practice. Design/Methodology/Approach: The study adopted a systematic literature review (SLR), a mode of research which has been widely adopted and strongly justified for adoption in business and management research since the turn of the 21st century. The study conducted a content and thematic analysis on the commonalities and differences between private and public sectors and implication of the differences on public sector strategic performance measurement and management. The study itself covered 233 published and unpublished documents covering the seven decades to 2023 which to our knowledge constitutes the most comprehensive update on the public-private debate trends to date. Findings: The study thoroughly interrogated the literature perspectives or models on the commonalities and differences between the public and private sectors. The study then deep-dived into the underlying characteristics which differentiate the public and private sectors producing one of the most detailed side-by-side analyses of public-private differentiation based on organisational characteristics, dimension, or concept of all time. The systematic review further identified and derived several thematic areas related to public-private differences and went on to establish the implications of the public-private divergences from an SPMM perspective especially as it relates to the derivation and application of public sector performance measures. These findings are critical for both practitioners and academics as they explore the subject of transplanting private sector SPMM practices into the public sector which is another overripe area for research. The findings provide public managers with a comprehensive and critical cog in their management toolbox as they navigate the practical realities and difficulties of implementing SPMM in the public sector’s unique and complex environment. Research Limitations: The main challenge with conducting a comprehensive research of this magnitude relates mainly to the broad range of literature covered, the unwieldy and onerous analysis and lots of judgement calls which could impact bias and replicability. Practical Implications - This paper conducts a comparative analysis of the key features of the private and public sectors found in the literature and evaluates how they drive attendant management practices in the two sectors and specifically how the public sector’s distinctive nature impacts on the measures of performance. Originality/value - Studying the differences and how they impact the choice of public sector KPIs is crucial in attempting to address the myriad of challenges and potential hindrances to future institutionalisation of SPMM in contemporary PSOs. Exploring and understanding the differences and similarities between public and private sectors is a beneficial springboard to cultivate erudition, cross-pollination and facilitation of knowledge transfer between the two sectors of the contemporary global political economy. Keywords: Strategic, performance management, performance measurement, performance measures, key performance indicators, public-private differences DOI: 10.7176/PPAR/13-2-03 Publication date: March 31 st 2023

Tuberculosis control needs a complete and patient-centric solution.

Can Cyprus overcome its health-care challenges?

BACKGROUND Breast cancer is the most common cancer among Brazilian women. HER-2 targeted therapy improves overall survival in HER-2 overexpressing patients but immunohistochemistry testing for HER2 is not standardized in Brazil and is not available universally. In Brazil the health system includes a public and private sector. The aim of our study was to delineate the patterns of testing of HER-2 over time in Brazil in both of these settings and to determine if any disparities exist in testing and treatments received. METHODS Observational, retrospective study involving practice patterns of over 2000 cancer physicians in Brazil. We obtained de-identified data from a commercial database, which included 54,829 patients with breast cancer treated between 2012 and 2016. We analyzed the frequency of HER-2 testing, the percentage of positive results and the most common treatments used in the first line setting in both the private and public sector. The chi-squared test was used for proportions. RESULTS HER-2 testing was frequently performed in both the private and public sector (87% vs. 81%, p&amp;lt;0.0001. Between 2012 and 2016 most patients had HER-2 testing (88%, 73%, 79%, 90% and 88%, respectively) but coverage was not universal. The percentage of HER-2 positivity was 25%. The most common first line regimens used were docetaxel/trastuzumab, paclitaxel/trastuzumab and trastuzumab monotherapy. In the private sector trastuzumab/pertuzumab/docetaxel was the most commonly used regimen. In the public sector taxanes were frequently used as monotherapy without HER-2 targeted therapy. CONCLUSIONS To our knowledge this is the largest dataset assessing HER-2 testing and treatment patterns in Brazil. The frequency of testing has remained stable over the last 5 years, but is higher in the private sector and this finding was highly statistically significant. There are also differences in the regimens used in the private vs. public sector. Pertuzumab was approved in 2013 in the US and its use has increased in Brazil over the last two years. This trend however was only seen in the private sector. In the public sector there is still significant use of chemotherapy without HER-2 directed therapy despite HER-2 overexpression, which is possibly related to the restricted access of anti-HER2 therapy in the public health system for metastatic patients. Taxanes are used widely in both the public and private sector, which is possibly related to the availability of generics. HER 2 Testing in the Public Sector20122013201420152016Tested4,2853,7114,5924,6884,126%92%76%80%94%91%Non Tested36211441134322428%8%24%20%6%9%Total4,6474,8555,7265,0104,554 HER 2 Testing in the Public Sector20122013201420152016Tested5,3913,9964,9175,2084,945%85%71%78%87%85%Non Tested9491,6611,367761842%15%29%22%13%15%Total6,3405,6576,2845,9695,787 Citation Format: Palacio S, Torres A, Prado E, Lopes G. Breast cancer in Brazil: HER-2 testing and treatment patterns [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-20.

Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON

BackgroundEnsuring health worker job satisfaction and motivation are important if health workers are to be retained and effectively deliver health services in many developing countries, whether they work in the public or private sector. The objectives of the paper are to identify important aspects of health worker satisfaction and motivation in two Indian states working in public and private sectors.MethodsCross-sectional surveys of 1916 public and private sector health workers in Andhra Pradesh and Uttar Pradesh, India, were conducted using a standardized instrument to identify health workers' satisfaction with key work factors related to motivation. Ratings were compared with how important health workers consider these factors.ResultsThere was high variability in the ratings for areas of satisfaction and motivation across the different practice settings, but there were also commonalities. Four groups of factors were identified, with those relating to job content and work environment viewed as the most important characteristics of the ideal job, and rated higher than a good income. In both states, public sector health workers rated "good employment benefits" as significantly more important than private sector workers, as well as a "superior who recognizes work". There were large differences in whether these factors were considered present on the job, particularly between public and private sector health workers in Uttar Pradesh, where the public sector fared consistently lower (P < 0.01). Discordance between what motivational factors health workers considered important and their perceptions of actual presence of these factors were also highest in Uttar Pradesh in the public sector, where all 17 items had greater discordance for public sector workers than for workers in the private sector (P < 0.001).ConclusionThere are common areas of health worker motivation that should be considered by managers and policy makers, particularly the importance of non-financial motivators such as working environment and skill development opportunities. But managers also need to focus on the importance of locally assessing conditions and managing incentives to ensure health workers are motivated in their work.

Employers often have prejudices and negative stereotypical attitudes regarding the employment of persons with disabilities (PwD). This is a part of the conclusion of D1.1 Report - Identify and analyze the needs of employers within School-to-Work Transition for Higher education students with disabilities in Serbia, Bosnia & Herzegovina and Montenegro (Trans2Work) project. We are interested in whether there is a difference in attitude between employers in the public and private sectors when it comes to hiring persons with disabilities. The aim of the research was to examine the attitudes of employers in the private and public sectors regarding the employment of persons with disabilities. We hypothesized that employers in the public sector had more positive attitude towards the employment of persons with disabilities in relation to employers in the private sector. The study sample consisted of companies from the private and public sectors in one of two entities in Bosnia and Herzegovina - Republic of Srpska (60 companies in the private sector and 60 companies in the public sector). In this research, we used the Questionnaire about employment of the people with disabilities, which examines the attitude of the employers about employment of the persons with disabilities. The Questionnaire consisted of 19 questions. Employers were asked questions related to the employment of persons with disabilities. The Questionnaire had good reliability and Cronbach alpha coefficient was 0,89. We used two methods in the study: the survey method and the method of theoretical analysis. We used the survey method to conduct data collecting through research instruments, data processing and analysis of the results, while the methods of theoretical analysis were necessary for collection and selection of relevant information from the former methodological and subject-related researches. Results confirmed the assumption that employers in the public sector had more positive attitude towards the employment of persons with disabilities compared with the employers in the private sector. Complete and thorough analysis would be shown in the paper. We hope that the results will contribute to the existing literature related to the employment of persons with disabilities and project Trans2Work in general.

The operations and effectiveness of public and private provision of solid waste collection services in Kampala

Increasing number of litigation suits against internal auditors has proved that there is heightened scrutiny on the quality of internal auditor’s judgment. As internal auditor’s judgment relies highly upon by the stakeholders, this paper aims to identify the types of audit judgment deemed to be critical for the success of an audit engagement. It also explores the types of objectivity threat experienced by Malaysian internal auditor. The present study also examined if there had been significant difference between objectivity threat experienced by public sector internal auditors and those of the private sector. The paper opted for an exploratory study using the questionnaires. A total of 150 copies of questionnaire were distributed to internal auditors working in private and public sectors. The findings indicated risk judgment (judgment on existing and emerging risk faced by organisation) as the most critical success factor in internal audit engagement. The findings also revealed that social pressure, cognitive biases, and intimidation as the top three threats that could threaten internal auditor objectivity, thus possibly affect internal auditor ability to make an objective judgment. However, this study found that there was no significant differences between the objectivity threats experienced by internal auditors in the private sector and those in the public sector. The research extent internal auditing literatures which focuses on the factors influencing internal auditor’s objectivity, but tended to omit the impact of the objectivity on influencing internal auditor’s judgment. This study has provided evidence of potentially serious risk of objectivity threats that may impair the internal auditors’ objectivity, thus reducing their ability to make an objective judgment. This paper fulfils an identified need to study flaws in internal auditor’s judgment and the existences of objectivity threat in Malaysian internal audit environment regardless either in public or private sector.Increasing number of litigation suits against internal auditors has proved that there is heightened scrutiny on the quality of internal auditor’s judgment. As internal auditor’s judgment relies highly upon by the stakeholders, this paper aims to identify the types of audit judgment deemed to be critical for the success of an audit engagement. It also explores the types of objectivity threat experienced by Malaysian internal auditor. The present study also examined if there had been significant difference between objectivity threat experienced by public sector internal auditors and those of the private sector. The paper opted for an exploratory study using the questionnaires. A total of 150 copies of questionnaire were distributed to internal auditors working in private and public sectors. The findings indicated risk judgment (judgment on existing and emerging risk faced by organisation) as the most critical success factor in internal audit engagement. The findings also revealed that social pressure, cognitive biases, and intimidation as the top three threats that could threaten internal auditor objectivity, thus possibly affect internal auditor ability to make an objective judgment. However, this study found that there was no significant differences between the objectivity threats experienced by internal auditors in the private sector and those in the public sector. The research extent internal auditing literatures which focuses on the factors influencing internal auditor’s objectivity, but tended to omit the impact of the objectivity on influencing internal auditor’s judgment. This study has provided evidence of potentially serious risk of objectivity threats that may impair the internal auditors’ objectivity, thus reducing their ability to make an objective judgment. This paper fulfils an identified need to study flaws in internal auditor’s judgment and the existences of objectivity threat in Malaysian internal audit environment regardless either in public or private sector.

Public-private mix (PPM) programs on tuberculosis (TB) have a critical role in engaging and integrating the private sector into the national TB control efforts in order to meet the End TB Strategy targets. South Korea's PPM program can provide important insights on the long-term impact and policy gaps in the development and expansion of PPM as a nationwide program. Healthcare is privatized in South Korea, and a majority (80.3% in 2009) of TB patients sought care in the private sector. Since 2009, South Korea has rapidly expanded its PPM program coverage under the National Health Insurance (NHI) scheme as a formal national program with dedicated PPM nurses managing TB patients in both the private and public sectors. Using the difference in differences (DID) analytic framework, we compared relative changes in TB treatment outcomes-treatment success (TS) and loss to follow-up (LTFU)-in the private and public sector between the 2009 and 2014 TB patient cohorts. Propensity score matching (PSM) using the kernel method was done to adjust for imbalances in the covariates between the 2 population cohorts. The 2009 cohort included 6,195 (63.0% male, 37.0% female; mean age: 42.1) and 27,396 (56.1% male, 43.9% female; mean age: 45.7) TB patients in the public and private sectors, respectively. The 2014 cohort included 2,803 (63.2% male, 36.8% female; mean age: 50.1) and 29,988 (56.5% male, 43.5% female; mean age: 54.7) patients. In both the private and public sectors, the proportion of patients with transfer history decreased (public: 23.8% to 21.7% and private: 20.8% to 17.6%), and bacteriological confirmed disease increased (public: 48.9% to 62.3% and private: 48.8% to 58.1%) in 2014 compared to 2009. After expanding nationwide PPM, absolute TS rates improved by 9.10% (87.5% to 93.4%) and by 13.6% (from 70.3% to 83.9%) in the public and private sectors. Relative to the public, the private saw 4.1% (95% confidence interval [CI] 2.9% to 5.3%, p-value < 0.001) and -8.7% (95% CI -9.7% to -7.7%, p-value <0.001) higher rates of improvement in TS and reduction in LTFU. Treatment outcomes did not improve in patients who experienced at least 1 transfer during their TB treatment. Study limitations include non-longitudinal nature of our original dataset, inability to assess the regional disparities, and verify PPM program's impact on TB mortality. We found that the nationwide scale-up of the PPM program was associated with improvements in TB treatment outcomes in the private sector in South Korea. Centralized financial governance and regulatory mechanisms were integral in facilitating the integration of highly diverse South Korean private sector into the national TB control program and scaling up of the PPM intervention nationwide. However, TB care gaps continued to exist for patients who transferred at least once during their treatment. These programmatic gaps may be improved through reducing administrative hurdles and making programmatic amendments that can help facilitate management TB patients between institutions and healthcare sectors, as well as across administrative regions.

BackgroundPublic–private mix (PPM) programs on tuberculosis (TB) have a critical role in engaging and integrating the private sector into the national TB control efforts in order to meet the End TB Strategy targets. South Korea’s PPM program can provide important insights on the long-term impact and policy gaps in the development and expansion of PPM as a nationwide program.Methods and findingsHealthcare is privatized in South Korea, and a majority (80.3% in 2009) of TB patients sought care in the private sector. Since 2009, South Korea has rapidly expanded its PPM program coverage under the National Health Insurance (NHI) scheme as a formal national program with dedicated PPM nurses managing TB patients in both the private and public sectors. Using the difference in differences (DID) analytic framework, we compared relative changes in TB treatment outcomes—treatment success (TS) and loss to follow-up (LTFU)—in the private and public sector between the 2009 and 2014 TB patient cohorts. Propensity score matching (PSM) using the kernel method was done to adjust for imbalances in the covariates between the 2 population cohorts. The 2009 cohort included 6,195 (63.0% male, 37.0% female; mean age: 42.1) and 27,396 (56.1% male, 43.9% female; mean age: 45.7) TB patients in the public and private sectors, respectively. The 2014 cohort included 2,803 (63.2% male, 36.8% female; mean age: 50.1) and 29,988 (56.5% male, 43.5% female; mean age: 54.7) patients. In both the private and public sectors, the proportion of patients with transfer history decreased (public: 23.8% to 21.7% and private: 20.8% to 17.6%), and bacteriological confirmed disease increased (public: 48.9% to 62.3% and private: 48.8% to 58.1%) in 2014 compared to 2009. After expanding nationwide PPM, absolute TS rates improved by 9.10% (87.5% to 93.4%) and by 13.6% (from 70.3% to 83.9%) in the public and private sectors. Relative to the public, the private saw 4.1% (95% confidence interval [CI] 2.9% to 5.3%, p-value < 0.001) and −8.7% (95% CI −9.7% to −7.7%, p-value <0.001) higher rates of improvement in TS and reduction in LTFU. Treatment outcomes did not improve in patients who experienced at least 1 transfer during their TB treatment. Study limitations include non-longitudinal nature of our original dataset, inability to assess the regional disparities, and verify PPM program’s impact on TB mortality.ConclusionsWe found that the nationwide scale-up of the PPM program was associated with improvements in TB treatment outcomes in the private sector in South Korea. Centralized financial governance and regulatory mechanisms were integral in facilitating the integration of highly diverse South Korean private sector into the national TB control program and scaling up of the PPM intervention nationwide. However, TB care gaps continued to exist for patients who transferred at least once during their treatment. These programmatic gaps may be improved through reducing administrative hurdles and making programmatic amendments that can help facilitate management TB patients between institutions and healthcare sectors, as well as across administrative regions.

The frequency of the occurrence and type of oesophageal cancer from pathology laboratory data from the private and public sector has never been compared in KwaZulu-Natal (KZN). This study aims to compare data from the public and private pathology services in the province. All the malignant and pre-malignant oesophageal biopsies at the academic department of histopathology and at three private laboratories in the KZN were retrieved for comparison. Between January 2012 and December 2014, there were a total of 1087 new diagnoses of an oesophageal malignancy or pre-malignant diagnosis. There were 613 specimens from the private laboratories in KZN and 474 from IALCH. The sex distribution was (41%) females and (59%) males. In the private sector, the mean age was 61.6 years and in the public sector it was 62.7 years. (Range 18-75 years) Africans comprised 63% of the total, Whites 28% and Indians 7%. In the public sector 89.5 % of patients were African whereas in the private sector, Africans comprised 45.7% and Whites made up 46% of the total. Eighty-eight per cent of biopsy specimens were malignant lesions of which 68% were squamous carcinoma. Squamous carcinomas accounted for 87.5% and 54% of all lesions in the public and private sectors respectively. Pre-malignant lesions accounted for 5% and 23% of diagnoses in the public and private sectors respectively. Pre-malignant lesions in the public sector showed mainly dysplastic squamous cell dysplasia whereas dysplastic Barrett's oesophagus lesions accounted for the majority in the private sector. Oesophageal cancer is a major public health problem in KZN. Although squamous carcinoma predominates, adenocarcinoma is a significant problem in the White population. It would appear that surveillance for oesophageal adenocarcinoma is taking place in the private sector albeit in a non-systematic or coordinated fashion. This does not appear to be the case in the state sector.